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Lightbulb moments in D-management

Discussion in 'Parents of Children with Type 1' started by twodoor2, Jul 12, 2008.

  1. Flutterby

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    I think I've had a few 'lightbulb' moments, my most recent, when we were dealing with ketones the other night.. an adding that extra temp basal.. it really helped, and I could stop fighting the ketones and blood sugar..
     
  2. Abby-Dabby-Doo

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    Goofy as they sound- My first one was Bennet's famous saying "YDMV" or what works for one, doesn't work for the other. It's amazing to see how children differ from one thing to the next. Some go high from things, and others don't. A big one for Abby was pasta. If I do a full bolus for pasta she's going to plummet.
    A big one for me when we were struggling with the pump start was the insulin duration setting.
     
  3. sugarmonkey

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    Mine was when I found out that Phillips blood sugar wasn't going to stay stable, no matter what I did. Sometimes he'd go high, sometimes low. Our educator gave me the impression that once his bs came down to normal it would stay that way, as long as he took his insulin. Realising that wasn't true was a biggie for me.
    And finding this site, which is where I found out the above.
     
  4. bisous

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    This may sound so silly, but my big AHA moment was discovering that with the pump I could figure out how many points .1 units of insulin would drop DS. That allowed me to be a little bit more "aggressive" if you will in correcting him. For example, our target range is 70 to 120 and if DS is 35 the pump won't let me correct him because my sensitivity is too high. But since I know that .1 is approx 30 "points" lower I know I can safely give a bolus of .1 and he should end up around 105--a perfectly safe number!

    Oh! And here's another one that I just had. I just realized that I had been so trained to be afraid of lows from the time that DS was DX'd that I was running him higher than he needed to be. While lows can happen any time and they are always frightening, if your child can feel their lows, and they test often, you can afford to have a little tighter control.

    Good thread!
     
  5. Lisa P.

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    Just had another one, after reading about how fat can cause a spike up to ten hours later. I've read over and over people on this forum talking about fat causing a spike for their kids (twodoor2, e.g.) and told myself I was glad that didn't seem a factor for Selah. At the same time, we've been trying to figure out for several weeks now why her nights can all of a sudden get high for no reason. Aha! The spike is HOURS later -- some days she eats cheese all day for her free food. There you go!
     
  6. Anja821

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    My lightbulb moment was when someone mentioned we have to pinch an inch when inserting the infusion sets so the insulin gets into the fat layer. I had be lax in doing that, then wondering why my son's BGs were so high.
     
  7. kyleesmom

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    My most recent one: Hydrocortisone can and does do wacky things to blood sugar. It makes her high and apparently more insulin resistant.

    Biggest help: Swimming makes Kylee go sky high and without fail, two hours after she has stopped doing it, she will go low. Drinking Gatorade or another similar sports drink during swimming will prevent that all from happening.

    Led to the biggest change in management: Im just as capable of making changes to insulin dosages as the endo is. I do not need to wait for confirmation before adjusting things and if I dont feel something is right when it is suggested by the endo, I can say so.

    Most important one: Having diabetes did not suddenly turn my immature 10 year old into a mature adult who is capable of remembering everything and doing everything correctly. She is still just a kid, and she will forget her insulin at school and her poker in the car when we are out eating. She will set her meter and everything out to check her blood sugar, then leave to go wash her hands and immediately start eating, never realizing that she didnt actually check. She will eat an oreo with her friends when they are eating them and she doesnt want to leave to come home and get her insulin, and as a result have high blood sugar at dinner. She will run races right before dinner and spend hours making up dances with friends that will shoot her straight to the moon and then drop her back down just as quickly. She will have to be asked 1000 times if she has remembered her bag, her insulin, extra needles and strips, the Calorie King book, glucose tabs, juice, a snack, her "Red Pen" or any of the other things she needs in order to survive. But she is still just a kid and we have to remember that and allow her to be one.
     
    Last edited: Jul 13, 2008
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  8. LJS118

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    My lightbulb moment was realizing that diabetes can never be totally controlled
     
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  9. TheFormerLantusFiend

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    The first time I lowered Lantus and got better morning numbers- that was a big YES the symogii efect is real. I hadn't believed it before that.

    About Lantus and Novolog being equal, that's just a guideline for starting your dose, and each body is different. Especially in different age groups, the basal:bolus ratio is different.
     
  10. jules12

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    My moment was realizing that I was letting this rule my life - every waking moment was spent thinking about Diabetes, reading about Diabetes, etc. I realized I wasn't doing anyone any good, I was stressed and worn out - I have backed off a little, and you know, he is still in good control and has good a1c's.
     
  11. tuckerk

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    Well said. For awhile, I felt that I was being negligent when Caitie would have high numbers even if it were an error on my part or the part of someone else taking care of her. I realized that it is not fair to put her through unnecessary pain for the sake of bragging on how good her numbers are or to sound the smartest.

    This was major for me being that I practice medicine every day as an FNP. I was on a big EGO TRIP for awhile until I looked back and saw that I wasn't enjoying just being a good MOMMY to a healthy, perfect little girl. So glad I got this breakthrough, with the Diabetes and everyday life, LIFE IS GOOD!!!!!
     
  12. Lani

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    Good information - thanks for sharing!
    I have a question about BCR -when you say that 1 gram carb will raise BG 8-9 points - how to you determine this? Do you test a certain amount of time after he has eaten?
     
  13. twodoor2

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    Jacob'sDad may have his own take on this, but I test the BCR after all the bolus is completely out of the system. Depending on the type of fast acting, and how the body reacts to it, this can be anywhere from 3 to 5 hours after the last bolus. My daughter has an average duration of bolus insulin time of around 4.5 to 5 hours (it also depends on the size of the bolus). Five hours is a good time to wait. Then take the BG at that time, and give an accurate carb amount (about 3 carbs should suffice), and then wait around 3 hours, take the BG again, and the BCR is equivalent to

    (Ending BG-Starting BG) divided by # grams of carbs

    Now, there are weight charts for average BCR's for people. The BCR is affected by weight more than anything else. The less you weigh, the higher the BCR. Toddlers usually have a BCR of 12, preschoolers 10, older kids can be anywhere from 8 to 4 (usually kids over 100 pounds are around 4). The average 150 pound adult has a BCR of 4.
     
  14. wilf

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    2 insights, both from others' posts here:

    1) that hot baths, showers, hot tubs cause insulin to work much more quickly and lead to risk of lows;

    2) the valueof pre-bolusing.

    A third one which I found out for myself was the ower of "overbolusing" in maintaining good BG levels in my grazing DD..
     
  15. hawkeyegirl

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    I think BCR is actually pretty hard to accurately test for. Say I give my son a 5 carb mini-cookie after his supper bolus has left his system, right before bed. His starting blood sugar reading is 140 and his ending blood sugar reading is 180. That would lead me to believe that his BCR is 8. (180-140 divided by 5). But what if 15 points of that rise is just a "natural" variation in blood sugar level? Or 20 points of that rise? Or maybe his blood sugar level would normally drop 10 points during that time, so the cookie really caused a 50 point increase, but there is no way for me to know that? Basal rates, even on the pump aren't perfect - there is blood sugar variation, even with the most accurate basal settings.

    I think you have to test BCR a few different times, at different times of the day, and sort of average the results. I've pretty much figured out through trial and error that my son's BCR is somewhere between 7 & 10, and that's as close as I can get.
     
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  16. twodoor2

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    Good point, you do have to take into account natural fluctuations due to hormones and imperfect basal. I do think the weight charts can provide a rough estimate, and I've done the BCR tests so many times becasue that's how I can judge how much she'll rise if I need to give her a buffer at bedtime. Elizabeth is 54 pounds and her BCR is 8 mg/dl, which I think is the average for a child around 50 pounds, it can deviate +/- 2 mg/dl points from there.
     
  17. Mom2rh

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    The main "aha" moment was realizing that insulin is not like other medicine where less is better. After that realization and pardigm shift I could relax a lot more and let Ryan eat more normally.
     
  18. twodoor2

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    I almost forgot my biggest lightbulb moment that caused all corrections to go to less than 5% a day!! The ICR and the ISF are proportional and the ISF can be estimated by the followng calculation: ISF=ICR*BCR. When I figured this out, it was like magic for control. Management is still a lot of work, but this forced me to have multiple ISF's and to change them with ease instead of having to do tons of testing/analysis, or using one ISF the whole day as so many endo's prescribe with the super inaccurate 1800 Rule.

    This is great because if you have accurate basals, and accurate ICR, and you can get the BCR based on testing and/or weight, this gives a good estimate of the ISF for that time of day.

    Whoo Hoo!!

    Disclaimer: YDMV;)
     
    Last edited: Jul 16, 2008
  19. dqmomof3

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    Without a doubt, my lightbulb moment has been the BCR. Knowing Jayden's BCR has allowed me to adjust ISFs, and makes me much more secure in knowing how much carb to give to get her bg at least close to where I want it.
     
  20. Heather(CA)

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    My most important light bulb moment was finally figuring out that Gatorade works for intense activity and WHY it works. :D Whew!

    Also figuring out how to treat a rebound so they don't stay high for a long period of time:D
     

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